<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pharmaceutical_factory_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pharmaceutical_factory_id" data-rule="required" data-source="pharmaceutical/factory/index" class="form-control selectpage form-control" name="row[pharmaceutical_factory_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Medicine_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-medicine_id" data-rule="required" data-source="medicine/index" class="form-control selectpage form-control" name="row[medicine_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Argno')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-argno" class="form-control form-control" name="row[argno]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" class="form-control form-control" name="row[name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Market')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-market" class="form-control selectpicker" name="row[market]">
                {foreach name="marketList" item="vo"}
                    <option value="{$key}" {in name="key" value="0"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Date')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-date" class="form-control datetimepicker form-control" data-date-format="YYYY-MM-DD" data-use-current="true"
                   name="row[date]" type="text" value="{:date('Y-m-d')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Isindex')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-isindex" class="form-control selectpicker" name="row[isindex]">
                {foreach name="isindexList" item="vo"}
                    <option value="{$key}" {in name="key" value="0"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Event')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-event" class="form-control form-control" name="row[event]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Doctor')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-doctor" class="form-control form-control" name="row[doctor]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pdffiles')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-pdffiles" class="form-control form-control" size="50" name="row[pdffiles]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="plupload-pdffiles" class="btn btn-danger plupload"
                                  data-mimetype="pdf"
                                  data-preview-id="p-avatar"
                                  data-input-id="c-pdffiles"
                                  data-multiple="true"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-pdffiles"></span>
            </div>
            <ul class="row list-inline plupload-preview" id="p-avatar"></ul>
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
